Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Diagnosis
1. Computed tomography (CT) scan or multidetector CT angiography
If your doctor suspects the bleeding is within the brain itself, then CT scan is the best choice. Computed tomography (CT)
is the standard diagnostic tool uses
X-rays to make detailed pictures of structures inside the skull to
check for fractures and bleeding, specially in case of trauma. Scheduled repeat head computed tomography
after mild traumatic brain injury has been shown to have limited use
for predicting the need for an intervention. CT scan has correctly
identified over 95% of cases—especially on the first day after the onset
of bleeding. Others suggested that multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with SAH(15).
2. A Lumbar puncture
If CT scan can not identify the diagnosis, your doctor may suggest a lumbar
puncture (spinal tap). In the study to evaluate the Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture, showed that the 0.3 to 7% hemolysis which occurred was relatively independent both
of the time following SAH and of the number of red blood cells (rbc) in
the cerebrospinal fluid (CSF). There was, on the other hand, a
significant and time-dependent increase in CSF lactate concentration
early after SAH, suggesting the potential clinical value of the
detection of increased lactate with a relatively normal lactate/pyruvate
ratio in hemorrhagic CSF. Until this can be evaluated in human
subjects, however, determination of the rbc counts or total hemoglobin
concentrations in serially collected samples of CSF remains the best
clinical method(16).
3. ECG
ECG is found to be important in differetiating of SAH. In the study to
evaluate all patients admitted to a 31-bed department of intensive care
between
1993 and 2000 with acute aneurysmal SAH documented by cerebral
angiography or autops, indicated that of 159 patients (49.6 years
[range: 20-75]) with acute SAH, 106 (66.7%)
had abnormal ECGs (classified by an observer blinded to the patients'
clinical course and outcome. Conduction abnormalities were present in
7.5%. Arrhythmias occurred in 30.2%. By univariate analysis, the
presence of ST depression was related to outcome as assessed by the
Glasgow Outcome Scale (GOS) (15% poor outcome [GOS 4-5] vs. 1% good
outcome [GOS 1-3], p<0.05)(17).
4. Etc.
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Sources
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
(15) http://www.ncbi.nlm.nih.gov/pubmed/20935079
(16) http://www.ncbi.nlm.nih.gov/pubmed/906062
(17) http://www.ncbi.nlm.nih.gov/pubmed/15301889
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